title: Comparing rates of distal edge necrosis in deep-plane vs subcutaneous cervicofacial rotation-advancement flaps for facial cutaneous Mohs defects.
abstract: OBJECTIVE
  The cervicofacial rotation-advancement flap is commonly used for facial defects. Decreasing the rate of distal edge necrosis (DEN) encountered with this flap would help prevent complications in sensitive areas such as the eyelid, lip, and nose.
  
  
  OBJECTIVE
  To compare the untoward occurrence of DEN between 2 surgical dissection methods for reconstructive cervicofacial rotation-advancement flaps. DESIGN, SETTING, PARTICIPANTS, AND EXPOSURE: A review was conducted of 88 patients who underwent cervicofacial flap reconstruction for Mohs ablative surgery between January 1, 2003, and June 30, 2012, by the senior author (A.A.J.). All patients had periorbital, midfacial, cervical, and/or lateral temporal/forehead defects following Mohs surgical ablation. Patients were categorized into 1 of 2 groups on the basis of the surgical technique used: subcutaneous (SC) cervicofacial elevation or deep-plane (DP) cervicofacial elevation. Subcategories of smokers and nonsmokers within each group were further reviewed. Statistical analysis of DEN between categories and subcategories was performed.
  
  
  RESULTS
  Sixty-nine patients were in the SC group and 19 were in the DP group. The mean defect size among both groups was 14.3 cm(2). The rate of active or recent smokers was 23% in the SC group and 11% in the DP group. The rate of DEN among nonsmokers in the SC group was 23% (n = 53) compared with 0% in the 17 DP nonsmokers (P = .03). The rate of smokers with DEN in the SC group was 75% and 0% in the DP group (P = .09). The mean area of DEN in the SC group was 0.8 cm(2).
  
  
  CONCLUSIONS
  Our statistically significant data indicate that DP dissection is a superior technique for avoiding DEN in nonsmokers. We found better outcomes in smokers as well. Thus, we strongly advocate the use of the DP approach as the criterion standard in cervicofacial flap elevation.
  
  
  METHODS
  3.
authors.affiliation: New York Center for Facial Plastic and Laser Surgery, Great Neck 2The New York Eye and Ear Infirmary, New York3Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Albert Einstein College of Medicine, Br.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Jacono
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, New York Eye and Ear Infirmary, New York.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Rousso
authors.affiliation: New York Center for Facial Plastic and Laser Surgery, Great Neck 7currently a medical student, Hofstra University School of Health Sciences and Human Services, Hempstead, New York.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Lavin
mesh_terms: D000368:Aged; D005153:Facial Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D015580:Mohs Surgery; D009336:Necrosis; D011183:Postoperative Complications / Q000517:prevention & control*; D012086:Reoperation; D012399:Rotation; D012878:Skin Neoplasms / Q000601:surgery*; D012907:Smoking / Q000453:epidemiology; D040521:Subcutaneous Tissue / Q000637:transplantation; D013524:Surgical Flaps; D016896:Treatment Outcome